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Usefulness of risk scoring at booking for antenatal care in predicting adverse pregnancy outcome in a rural African setting
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
2002 In: Journal of Obstetrics and Gynaecology, ISSN 0144-3615, Vol. 22, no 6, 604-9 p.Article in journal (Refereed) Published
Place, publisher, year, edition, pages
2002. Vol. 22, no 6, 604-9 p.
URN: urn:nbn:se:uu:diva-93616OAI: oai:DiVA.org:uu-93616DiVA: diva2:167146
Available from: 2005-11-02 Created: 2005-11-02Bibliographically approved
In thesis
1. Assessing Antenatal Care in Rural Zimbabwe
Open this publication in new window or tab >>Assessing Antenatal Care in Rural Zimbabwe
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Antenatal care has been associated with improved maternal and perinatal outcomes but there is no agreement on the most effective model in terms of content as well as the number and timing of visits. A cluster randomised controlled trial was conducted in a rural area of Zimbabwe to assess a 5-visit goal-oriented antenatal care model against standard care. In the same population was also determined the sensitivity of factors used for risk screening to predict pregnancy complications and the effectiveness of the referral system in managing women with identified risk markers or pregnancy complications.

Pregnancy records of 10 572 out of total 13 517 recruited women were available for analysis. The new model did not change the number of visits but resulted in better use of health care. The classical risk screening system had low predictive value and identified too large a risk group for referral. Nulliparous women had an increased risk for pregnancy complications whereas women with previous uncomplicated pregnancies were at low risk of complications even with high parity. Multiparous women with previous complications had an increased risk of complications but better utilisation of health care services for delivery reduced adverse perinatal outcomes. There was a functional referral system in Gutu and women complied with referral indications but efficiency of the system was reduced by failure of care providers to comply with referral recommendations.

Antenatal care can be improved in a rural setting through a focussed programme and the unpredictability of many pregnancy complications limits the value of antenatal risk screening. Until universal access to essential obstetric care facilities is attained in low resource settings, a critical re-examination of risk factors could avoid overburdening the referral system.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2005. 65 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 78
Obstetrics and gynaecology, antenatal, pregnancy complications, referral, risk factors, pregnancy outcome, rural, Zimbabwe, Obstetrik och kvinnosjukdomar
National Category
Obstetrics, Gynecology and Reproductive Medicine
urn:nbn:se:uu:diva-6018 (URN)91-554-6372-X (ISBN)
Public defence
2005-11-23, Rosénsalen, Akademiska sjukhuset, Ing 95/96, nbv, Uppsala, 09:15
Available from: 2005-11-02 Created: 2005-11-02Bibliographically approved

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